OBJECTIVES: Schizophrenia is a serious mental disorder that requires lifelong treatment. Early treatment can help get symptoms under control before serious complications develop (e.g., suicide, anxiety disorder, aggressive behavior, depression, alcohol/drug abuse, inability to work, financial and health/medical problems). This research evaluated treatment patterns in patients newly diagnosed with schizophrenia in two populations with commercial versus Medicaid insurance.

METHODS: A retrospective cohort analysis of adults age 18+ and newly diagnosed with ≥1 inpatient or ≥2 outpatient claims with schizophrenia diagnosis and continuously enrolled for ≥6 months pre-index with no evidence of schizophrenia and ≥12 months post-index. Patient characteristics were measured at baseline.

RESULTS: A total of 5,388 commercial and 65,240 Medicaid patients with schizophrenia were identified. Commercial patients were younger compared to Medicaid (mean age 40.6 vs 45.4). Both populations were 60% male. Medicaid patients were more likely to have Charlson Comorbidity Index scores ≥2.0 (17.8% vs 11.1%). Antipsychotic medication was the first treatment prescribed for 36% of commercial and 27.6% of Medicaid patients, followed by dual therapy antipsychotic + antidepressant in 13.7% of both cohorts, antipsychotic + antianxiety in 9.7% and 8.1%, and antidepressant + antianxiety in 5.7% and 7.1%, respectively. A small percentage were prescribed an antidepressant (4.8%) or antianxiety (5.8%) only as first treatment. Of those first prescribed an antipsychotic, 18.2% commercial and 22.4% Medicaid patients remained on the treatment until end of follow-up (mean 355 days), while half (50.7% commercial and 49.7% Medicaid) discontinued treatment after 128 and 111 days on average. Importantly, 24.2% of commercial and 30.4% of Medicaid patients received no treatment during the 12-month follow-up.

CONCLUSIONS: Results show a large percentage of newly diagnosed patients with schizophrenia receive no treatment in 12-months following diagnosis, and half discontinue treatment after ~4 months. Steps to assure patients receive appropriate treatment can prevent worsening symptoms and adverse health outcomes.